Accountable Care Organizations

The Affordable Care Act contains several provisions that support the development of Accountable Care Organizations (ACOs) to manage and coordinate care for beneficiaries. OIG guidance related to ACOs under the Affordable Care Act is below, along with related resources.

CMS and HHS Office of Inspector General (OIG) jointly issued an interim final rule with comment period establishing waivers of certain Federal laws-the physician self-referral law, the anti-kickback statute, and certain provisions of the civil monetary penalty law-in connection with the Shared Savings Program. The interim final rule with comment period is available online at http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27460.pdf

Medicare Shared Savings Program Waivers: Additional Guidance - This document contains additional guidance for Medicare Shared Savings Program participants with respect to the waivers of the physician self-referral law, the anti-kickback statute, and the civil monetary penalties (CMP) law in a document jointly prepared by CMS and the OIG.

The Federal Trade Commission and the Department of Justice jointly issued a "Statement of Antitrust Enforcement Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program" (Antitrust Policy Statement). The Antitrust Policy Statement is available online at http://www.ftc.gov/os/fedreg/2011/10/111020aco.pdf

On March 31, 2011 as part of a cross-agency, coordinated effort, several Federal agencies issued documents addressing legal issues regarding Accountable Care Organizations participating in the Medicare Shared Savings Program (Shared Savings Program).

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish accountable care organizations (ACO) under the Shared Savings Program. The CMS proposed rule is available online at http://www.cms.gov/sharedsavingsprogram

CMS and HHS Office of Inspector General (OIG) jointly issued a notice with comment period outlining proposals for waivers of certain Federal laws—the physician self-referral law, the anti-kickback statute, and certain provisions of the civil monetary penalty law—in connection with the Shared Savings Program. CMS and OIG also sought comments on further waiver design considerations for the Shared Savings Program and for the separate waiver authority for the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act. The joint notice with comment period is available online at http://www.gpo.gov/fdsys/pkg/FR-2011-04-07/pdf/2011-7884.pdf

And the Internal Revenue Service (IRS) issued a notice requesting comments regarding the need for guidance on participation by tax-exempt organizations in the Shared Savings Program through ACOs. The IRS notice is available online at http://www.irs.gov/pub/irs-drop/n-11-20.pdf